Laserfiche WebLink
f 1Z. C i-;>7l, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d _ o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for thi work Z H o <br /> described and located as shown herein. The undersigned agrees that all work shall be done inaccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with al other - <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. R ' ^ <br /> OWNER TELEPHONE <br /> 5 - _34) <br /> HOME ADDRESS �Wl C Loa <br /> L-I/� d, vuj g I <br /> J F-V 7l (/11 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> q <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE o <br /> ADDITION o ,�.c <br /> y O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION--L a <br /> STRUCTURE/ADDITION USE: 1. V. I I I ' 4� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) A <br /> O 3 <br /> 'n v <br /> 1. All required dimensions or distances to be shown or drawn to scale. To <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate mH' <br /> North (N). C 0 <br /> 3. m <br /> Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlineof <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or rivE r. <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. C� <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must e <br /> signed and dated by the owner. <br /> ig <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: ° <br /> o � <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE . <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Z <br /> PERMITTED. :b <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OFT E <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. <br /> 7. a °Ca �oN�00nf m <br /> m .no am <br /> Q < M ` EM M <br /> 2 Wo (p <br /> 8. z f <br /> i'ii € L7 c m <br /> I <br /> (� ` m m declare that this application (including any accompanying schedule) has been examined by me and to the best f my )c/: <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of N y am„ m <br /> all Information contained fn this applicatlon(including any accompanying schedule)and I further declare that I recol inize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether o is. <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am O o <br /> providing in this applicatlon. I agree to permit county ofgeials charged with administering county ordinances or other ig <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> V N <br /> SIGN HERE '^ <br /> (signature of owner or building contractor) (date) o <br /> ZONING ADMINISTRATOR a o <br /> N N(n N N N f T m <br /> TOWNSHIP PERMITS MAY BE REQUIRED O u non n u o <br /> oc) o0o000 (mp <br />